Not Just a Pretty Face Craig Reisser Corby Barnes [email protected] Families Through Surrogacy 4-5 June 2016

Oregon Reproductive Medicine • Founded in 1989 - more than 25 years building families – patients from 40 countries

• Largest fertility clinic in the Pacific Northwest with approximately 1,000 egg collection cycles in 2015

• State-of-the art “clean-room” embryo laboratory designed by engineers who have also designed the fabrication plants at Intel in Oregon

• In-house egg donor program • In-house genetics team and laboratory • Consistency in live birth rates

A Brief History of Donor Eggs

• The first child born from egg donation was reported in Australia in 1983 at the Monash IVF clinic

• The first child born from egg donation in the USA was on February 3, 1984

• Egg and embryo donation now account for approximately 18% of IVF births in the USA

What should IPs be thinking about? 1

What are you looking for? What is the most important feature in a donor?

2

Not all screening is the same

3

What makes a good match?

4

Understanding the medical and genetic information

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Understanding the costs of egg donation

Give yourself the best opportunity for success on the first attempt

Where to Find Egg Donors IVF Clinics Pros: • In-house testing • Full prior cycle information • Medically approved • Donors known in-person • Typically local donors • Cost Cons: • Smaller databases

3rd Party Agencies Pros: • “Larger” databases • Specialist databases Cons: • Not medically approved • Non-medical staff • More arms-length • Geographically diverse • Cost

There are more than a hundred IVF Clinic and 3rd Party Agency Egg Donor Programs in the USA – also International Agencies

Fresh vs. Frozen Eggs Fresh Eggs Pros: • Higher success rates • Likely higher number of embryos • Most up to date testing • Full range of “known” v. “anonymous” possibilities Cons: • Cost • Potentially timing

Frozen Eggs Pros: • Potentially lower cost • Immediate availability Cons: • Lower success rates • Potentially fewer number of embryos • Less information typically available • Testing / information may not be up to date • More typically anonymous

Some IVF Clinics have Donor Egg Banks and there are 3rd Party Donor Egg Banks

Egg Donor Screening – ORM Example • In depth health history- reviewed, evaluated, confirmed • Genetic consultation on personal and family health history • Initial evaluation – personal interview, AMH, ultrasound, drug screen, communicable disease testing • Genetic testing – carrier and/or chromosomal testing

• Psychological consultation and MMPI-2 Screening and medical approval protocols vary by agency / IVF Clinic At ORM only 7% of applicants are approved

Information Available to IPs • Personal background – e.g. education, interests • Photos • Physical and ethnic characteristics • Medical background • Genetic testing • Donor medical – AMH, BAF • Prior donation outcomes • Reasons for donating • Anonymous v. known • Costs

In the USA there is a lot of information available to IPs – at ORM our donor profiles are around 25 pages long

Medical Factors for Successful Donation • Age – Peak fertility during a woman’s 20s – Above 35 the rate of abnormal embryo formation increases substantially

• BMI (Body Mass Index) – Can impact the effectiveness of fertility medications

• BAF (Baseline Follicle Count) – The number of follicles in the donor ovary that will create an egg – ORM minimum is 20

• AMH ( Anti-mullerian Hormone) – Provides an indication of a donor’s egg reserve – ORM minimum is 2.0

• Prior Donation Information- if applicable – Important to view cycle as a whole – number of eggs retrieved, fertilization rate, blastocyst embryros, “normal” embryo rate – Ongoing pregnancy / live birth outcomes – Medication dosages – ASRM guidelines are for no more than 6 egg donations

Cost and Timing Considerations Cost • Agency Fee • Screening costs

Timing •

Waiting for a surrogate is typically the “timing” gating item

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Typically finding a donor quicker process

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90-day window from donor selection to cycle at ORM

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Donor availability is therefore key

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Frozen embryo cycles can give IPs more flexibility on timing for selecting a donor

• Donor compensation • Legal costs

• Travel • Local monitoring

Final Words of Advice

1

Take your time to get used to looking at donor profiles

2

Prioritise what is important for you in a donor

3

Ask questions and engage with the resources available to help you find a match

4

Budget cost and timing for a smooth journey

Thank You